Trends and patterns of medical stimulant use by US adults

The authors describe trends in stimulant prescribing to US adults and characterize stimulant-treated adults by use of three modalities: telehealth only, in-person only, or mixed (hybrid) behavioral healthcare. Among US adults in the 2018-2023 Medical Expenditure Panel Survey (n = 119,138), annual stimulant treatment rates are presented with age- and sex-adjusted marginal 2018-2023 differences across sociodemographic and clinical strata. Characteristics of stimulant-treated adults are also presented by reason for stimulant use (attention-deficit/hyperactivity disorder vs. other) and behavioral healthcare modality. Between 2018 and 2023, medical stimulant use increased from 1.8% to 2.2% of adults, including greater increases for adults with household incomes >400% than <100% of the Federal Poverty Level and employed adults than non-employed adults over age 65. However, the percentage of patients receiving ADHD visits who were treated with stimulants declined from 81.6% in 2018 to 74.6% in 2023. In 2021-2023, 48.4% of stimulant-treated patients received all their behavioral healthcare as in-person visits rather than hybrid (30.9%) or telehealth only (20.7%). These three groups did not differ in the percentage who received stimulants for ADHD, the number of stimulant prescriptions they received, or benzodiazepine or opioid prescriptions. In summary, between 2018 and 2023, adult stimulant use increased, particularly among higher-income and employed adults, while the share of ADHD patients treated with stimulants declined. Approximately one-half of stimulant-treated patients received teletherapy, and service modality was not related to ADHD treatment, stimulant prescription counts, or benzodiazepine or opioid prescriptions.